Technology in Medical Education

Like many of you, I watched Apple's much anticipated reveal of the new iPhone 8 and iPhone X. Sure, they're pretty, they have nice cameras, wireless charging, and Face ID, but what really caught my attention was the new augmented reality platform. iOS 11 will launch this month with ARKit, a set of developer tools that will make it much easier to design apps with augmented reality experiences. I am not a techie or a gamer, and I only have minimal experience with virtual reality (VR) or augmented reality (AR). However, I think these technologies have huge potential for Medical Education.

VR and AR are already being used in med ed. These technologies can facilitate basic anatomy instruction, procedural training, and simulation of patient interactions. More importantly, learners can view the anatomy and practice their skills without the need for cadavers, pig labs, standardized patients, etc. Don't get me wrong, I loved my anatomy labs. They play an integral role in medical education. But these labs are expensive to operate and you can only dissect each cadaver once. AR and VR provide students with a realistic learning environment and require fewer resources than conventional methods.

Virtual Reality (VR): creates a realistic, virtual world that users can interact with. Typically requires a helmet or goggles.

Augmented Reality (AR): blends virtual reality with real life. Users interact with virtual content in the real world, and can distinguish between the two. May use a headset or goggles, but can also be done with a handheld device.

Several VR medical training platforms are already available. Some focus on creating realistic, emotional, patient interactions, while others offer more skills based applications. Osso VR, for example, provides a realistic surgical training environment, allowing surgeons to go through the steps of performing an operation in an immersive VR environment. Their product is currently geared toward Orthopedics, but they plan to expand to include other specialties and procedures. The real advantage here is repetition - trainees can perform procedures and operations multiple times in VR before ever performing them on a live patient. In the Emergency Medicine world, this would be especially useful for practicing rare procedures, like cricothyroidotomy and pericardiocentesis. ​

AR platforms, such as Microsoft HoloLens, also have intruiging implications for Med Ed. With HoloLens, the wearer sees a holographic image projected in front of them in space, but also sees the room and other people as they are (hence AR, not VR). For example, students can examine the anatomy of the heart in 3D space, rotating it and looking inside the organ. Even more exciting is the way students can interact with the hologram, peeling back layers, watching blood pump, or adding labels. Case Western Reserve has been piloting HoloLens with great success and and are now working on creating a full digital anatomy curriculum.

So, where does the iPhone fit in? The new iPhones (8, 8 Plus, and X) all support apps built on Apple's new AR platform, and I suspect the next generation of iPads will, as well. While this may not be quite as cool or realistic as an immersive VR environment or interactive hologram effect, it is far more accessible. Developers are probably already hard at work building educational apps that will soon be available to anyone with an iPhone. Whereas products like Osso VR and HoloLens are still likely limited to use in the classroom or simulation centers, any student, resident, or practicing health professional will be able to access the iPhone's AR apps anytime, anywhere (and, probably, at a much cheaper price). Just check out Insight Heart for a preview of what's ahead. I'm calling it now, this will be a game changer.

​We are all academics. Even if you work in a 4 bed ED, 1000 parsecs from civilization. Attendings, residents, nurses, mid-level providers, medical students. Healthcare fundamentally requires adherence to lifelong learning. Therefore, we are all academics. Maybe not in the “publishpublishpublish” sense of the word, but we are, collectively, inquisitive, curious, dedicated and always slightly unhappy with our knowledge base. And therefore we expand it by continuing to learn.

Learning during residency, though, is especially hard. As I’ve found out over the past 12 months. Aside from, you know, the actual time spent in the hospital, there are lectures, simulation sessions, teaching opportunities and, lest you forget, that laundry basket that has been crying mercy for about 2 weeks now. Of course I learn while I’m on shift. But there’s so much more out there than what even a hoard of patients can give us.

When it came to my education, I often found myself left to my own devices. Electronic devices.

​I joined Twitter back in college. Mostly to follow my favorite sports writers and personalities. Not until maybe 3rd year of medical school did it ever dawn on me that there might actually be **smart people** on the internet. Smart people who could teach me something.

Twitter is the epitome of asynchronous. The best threads are instigated by momentary streams of consciousness. Trending hashtags change by the minute. There is no spaced repetition. The only standard is a 140 character limit, but even that can be circumvented if need be. It is the etch-a-sketch of the learning modalities: whether there is a flash of brilliance or muddled garbage on the screen, you just have to shake the screen to make something completely new to appear.

Twitter is the epitome of asynchronous, therefore it is an acquired taste. It takes some effort to dive in, but, with a little time and the right attitude, it will put incredibly rare and useful resources literally at your fingertips.

"Twitter is the epitome of asynchronous...incredibly rare and useful resources literally at your fingertips."

​Take the great Amal Mattu for example. Self proclaimed ECG nerd. Of all EM physicians, he is the Lord Commander of ECGs. EM:RAP, ALiEM, ECG Weekly, EMCast, ECG Video of the Week. The resume is impressive. And yeah, he’s on twitter. He posts pictures of whiteboards the size of 4K TVs that are plastered with knowledge that he drops on his shift. And yeah, it’s not a substitute for actually seeing patient’s with him, but you can be sure I have studied more than a few of his whiteboards to get a glimpse of what goes on in that wonderful brain of his.

Take Seth Trueger. The True(th), as I like to call him (In my own head). Maybe your palate craves a health policy flavor with a hint of snark? Check. Medical education, done with Star Wars references? His profile background is an X-wing fighter. He could likely write a dissertation on health policy. That maybe 15 doctors would read. Instead, he has 14+ thousand followers and he dispenses the knowledge in doses of a few words, mixed in with a lot of pictures and memes.

Take Katren Tyler. The Queen of the Retweet. She has perhaps single handedly reminded me that medicine is an international sport. She disperses knowledge from clinicians who practice in Australia and all over Europe. When she’s not making everyone else feel like a fatty for sitting on the couch all day, she’s busy connecting her followers with the goings on in Geriatric EM, health policy and the UC Davis EM residency program. Which, yes, means that she is the assistant program director of my residency program. So, yes, there is a bit of bias here. But hey, I gatta keep gettin’ them checks.

Take #EMConf. Yes, I used a hashtag in a space where the “#” does not automatically create a clickable hyperlink. But, if you type “EMConf” (which is a shortened version of Emergency Medicine Conference) into the Twitter search bar almost any day of the week, you’ll have more than a few educational pearls to thumb through from academic institutions all over the country.

​Perhaps Twitter hasn’t strengthened my grasp on the fundamentals of my specialty. It may not directly help me pass board exams. It did not teach me the importance of doing a full neurological exam on every patient that presents with a headache. I’ve used things I’ve seen on Twitter to teach while I’m on shift. I’ve learned invaluable lessons from the people I interact with, the stories I hear. It has expanded my horizons beyond the day-to-day grind of residency. It allows me to share ridiculous snippets about late night pages I’ve received. It allows me to try to go toe-to-toe with Amal Mattu’s whiteboard game. It’s part of my wellness. It has, without question, made me a better resident. A better doctor. Therefore, you should try it to.

When I started medical school, we came to class armed with a printout of the lecture slides and multicolored pens to take notes. No one had tablets and only a few chose to lug their heavy laptops to class. It didn't help that our wifi was patchy and slower than molasses...

Fast forward a decade - wifi is ubiquitous and most students have at least a smartphone, if not a tablet and/or laptop. These devices have become essential for reviewing lectures and other study material, taking notes, and taking advantage of a broad range of apps, podcasts, and other online resources.

With so many products on the market, it's hard to know what to choose. Watch below as four current medical students discuss their opinions on some of the more popular options.

*Educators, take note! How can we optimize our presentations and materials to align with the technology our students are using?

We'd love to hear from you! Was this helpful? What do you use? Leave your thoughts and feedback in the comments.

Medical education is changing. OK, yes, it's always changing. But I think we're approaching a major paradigm shift. As more programs adopt flipped classroom models and embrace the use of FOAM, where does that leave our current pre-clinical educators?

The traditional med ed model relies on professors to be the experts, imparting their knowledge to students through lectures and textbooks (often written by these same professors). I mean no disrespect to these educators, who are undoubtedly brilliant in their respective fields. Many have even mastered the art of the 50 minute lecture, providing engaging talks and visuals. But as medical practice is changing, so must education.

First of all, the sheer volume of information has increased drastically. It is impossible for today's students to fully comprehend and retain all of the material placed in front of them. More importantly, with easy access to apps and online references that are constantly updated, one could argue we shouldn't be teaching students to retain obscure bits of knowledge, but rather, how to seek out, synthesize, and apply the best information.

Secondly, continued medical advancements coupled with rapid sharing of information makes life-long learning essential. Students need to learn to actively seek out and participate in their own education. These skills are integral to a successful medical career. Standard lectures and textbooks may contain all of the relevant information (and more), but often don't engage students as well as some of the newer methods. Problem based learning (PBL), team based learning (TBL), and the flipped classroom are promising modalities for medical education, but need to be more widely implemented.

And then there is FOAM. Free open access meducation. Clinicians (especially those less tech savvy) are slowly embracing it. Students can't get enough of it. They are on blogs, social media, apps and quiz sites - some that they even have to pay for. We, as educators, need to be able to direct learners to the best content. And here is where the biggest shift occurs. Professors need to step away from writing lectures and become curators of information. For example, a flipped classroom course might require students to watch videos or complete modules on their own, and then participate in a team based learning or hands on session during class time. The key is that the pre-class materials need not be created by the professor - why reinvent the wheel when there is so much good stuff out there?

Of course, this is all new and controversial, and actively evolving. It is challenging to ask educators who have learned and taught one way for their entire career, to adopt a completely new model, especially one that relies less on their scientific knowledge and more on their teaching abilities. It may take a great deal more effort to create a flipped classroom session than to write a lecture in your area of expertise. Finding and selecting appropriate FOAM resources can be time consuming, as well. And then there is the issue is pride and prestige. How do educators set themselves apart when they are using materials created by another professor, often at another institution? And what if their strength lies in their knowledge of their area of expertise rather than in employing innovative education?

There are no easy answers and this movement will encounter may challenges. Those of us who want to be catalysts for change will have to work on breaking down barriers for current educators and facilitating a dialogue with students. We need to ask ourselves, what is in the best interest of our students? Students who are learning and practicing in our evolving, interconnected, technological world.

The average person in the United States now spends 2 hours per day on social media - or 30 days per year. Millenials spend even more; some up to 9 hours per day! Why on earth would we not hijack some of that time for education?! We must be at least as smart as the marketers of Silicon Valley. We need to find ways to reach students where they are, because many spend more time on social media than in the classroom.

Our students are already out there, getting news and advice, sharing ideas, and learning from online medical resources. It seems irresponsible of us - educators who have made it our life's work to teach the next generation of medical providers - to nothelp guide students to the best resources, integrate the vast array of knowledge on the web, demonstrate responsible use, and help build knowledge in a way that meets our core competencies. Social media is a powerful tool. It has the potential to crowd source information and filter the best resources. It's a forum for innovative ideas and creating new social connections students would not have made otherwise. It facilitates instruction on multiple different platforms, and drives student engagement in learning higher than ever before. FOAM continues to explode, with more students discovering it every day. But what resources are they using? How did they find them? Is anyone content letting Google decide?

If we want to guide and nurture this already exploding area of medical education, we should develop expectations, goals, and objectives, and strategies to meet them. A barrier we too often face is the failure of medical education leadership to recognize the importance of social media and FOAM. These are unlikely to be on their priority list and dedicated time in the "real curriculum" is tough to come by. How do we direct students to good resources, show them how to get what they need from FOAM, or teach responsible social media practices, when there is no time allotted to do so? Word of mouth? Email? The class Facebook page? For us, it is all of the above, and more. But we do not have the clear answer here. We need to hear your thoughts!

Developing your institutional goals and objectives comes first. Linking your student body in the next step. But how best to link is up in the air. Twitter? Slack? Facebook? This blog could be one platform! We communicate with our students via email and Facebook. We've started a student interest group for technology in medical education to engage students and develop new ideas. We are introducing a lecture/workshop series covering a wide range of topics related to tech in med ed. We hope to connect everyone via Twitter, as well as a platform like Slack, where topics can be discussed safely, resources shared, and education pushed forward.

It is an exciting time in medical education and we are ready to join the movement. Now to just get buy in from leadership and the rest of the faculty...

I guess it's best to start by being honest. I'm not a natural "techy". I grew up with rotary phones, sent my first email in high school, and didn't get a cell phone until after college <gasp!>. So why is someone like me so fascinated by technology? Because I've caught a glimpse of what it can do for medical education.

Learner Engagement. Remember trying to stay awake while a professor prattled on in front of text-filled blue slides? Or reading a textbook passage over and over because your mind kept wandering off to more interesting places? It doesn't have to be that way. Around the time I was in medical school, the Med Ed world started to change. Blogs popped up. And podcasts. And YouTube videos. And so much more! It was like The Wizard of Oz - we'd been living in black and white, and, suddenly, a technicolor world opened up with dazzling new ways to learn.

FOAM. Free Open Access Meducation. If you haven't heard of this yet, head over to your favorite Social Media site at type in "#FOAMed". You'll find the latest tutorials, pearls, quizzes, graphics, and research, laid out on a virtual platter for your consumption. New content is being created, added, and refined every minute. Indeed, the biggest challenge may be sifting through to find the best material. Luckily, many educators have taken on the role of curator to do just that. It's exciting and fresh - and it's free!

Global collaboration. Medical education now extends far beyond your classroom, hospital, or institution. The conversation is global. Through social media, students and educators from all over the world connect to share content and ideas. We can discuss our shared passion with people we otherwise may never have known.

And this is really just the tip of the iceberg. If you're a doctor, nurse, PA, dentist, paramedic, pharmacist, professor, student, or anyone else interested in progressive medical education, I hope you'll join me on this adventure to explore the world of technology in med ed. It's about TiME.